Category: Statistics

JMIR Res Protoc. 2025 Jul 3;14:e71927. doi: 10.2196/71927.

ABSTRACT

BACKGROUND: Adolescent tobacco and nicotine use is a major public health concern, with lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents showing disproportionately high use compared to their heterosexual and cisgender peers. Research suggests factors such as socialization, stress, mood, and craving exacerbate tobacco and nicotine use. However, there is a dearth of knowledge of how these factors influence tobacco, nicotine, and cannabis use among LGBTQ+ adolescents in general and particularly on a momentary basis.

OBJECTIVE: This study aims to use ecological momentary assessment (EMA) to assess real-time predictors of tobacco, nicotine, and cannabis product use among LGBTQ+ adolescents.

METHODS: The Puff Break protocol was adapted from existing EMA protocols, key informant recommendations, LGBTQ+ adolescent perspectives, and insights from community members. Recruitment occurred through multiple channels, with high recruitment results via social media. Eligible participants were aged 14 to 19 years; self-identified as LGBTQ+; and used tobacco, nicotine, or cannabis products at least once in the past 30 days. The EMA pilot began with a 1.5-hour in-person or remote meeting where participants completed a timeline follow-back assessment for tobacco and nicotine use, salivary cotinine assessment, baseline survey, and EMA protocol training. Then, participants completed a 2-week EMA trial during which they received 1- to 2-minute surveys 5 times a day. Within a week of completing the EMA trial, participants concluded with an exit survey and exit interview.

RESULTS: Funded in July 2022, the Puff Break study conducted EMA data collection between August 2023 and November 2024, recruiting a sample of 50 participants. Analyses evaluating the feasibility and acceptability of the Puff Break EMA protocol will be completed by July 2025. Multilevel modeling techniques to estimate both contemporaneous and lagged associations among stress, socialization, and craving (exposures) and smoking (outcomes-combustible cigarette, smokeless product, e-cigarette, and cannabis use) are expected to be completed by November 2025. Finally, qualitative thematic analyses to identify robust tailoring variables, intervention options, and decision rules to support future just-in-time-adaptive intervention development are expected to be completed by May 2026.

CONCLUSIONS: Puff Break is an innovative EMA protocol developed to capture factors influencing tobacco, nicotine, and cannabis use among LGBTQ+ youth. Despite some inherent limitations to the EMA design, the Puff Break protocol has the potential to inform the development of a just-in-time-adaptive intervention to reduce tobacco, nicotine, and cannabis use among LGBTQ+ adolescents.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/71927.

PMID:40609086 | DOI:10.2196/71927

JMIR Public Health Surveill. 2025 Jul 3;11:e69768. doi: 10.2196/69768.

ABSTRACT

BACKGROUND: Avoidable hospitalizations (AHs) have been widely used in high-income countries as a proxy indicator for the quality of primary care. However, it is rarely evaluated in low- and middle-income countries such as China. Studies examining changes in AHs before and during the COVID-19 pandemic are also limited. The appropriateness of AHs as an indicator measuring primary care quality under pandemic conditions has not been well discussed.

OBJECTIVE: This study aims to describe trends in AHs in Beijing, China, during both the prepandemic (2016-2019) and pandemic (2020-2021) periods and examine factors associated with AH rates.

METHODS: We used hospital discharge data of Beijing residents between January 1, 2016, and December 31, 2021. We identified AH cases from all discharge cases and calculated AH rates each year, adjusting for population structure changes. We performed regression analyses to explore factors associated with AH rates, where the COVID-19 outbreak, health care resources, and socioeconomic characteristics were used as the main explanatory variables.

RESULTS: Before the COVID-19 pandemic, the total number of hospital discharges in Beijing increased steadily from 2016 to 2019 but decreased sharply in 2020 and partially rebounded in 2021. The sex- and age-standardized AH rate per 100,000 population rose from 514.7 (95% CI 511.4-517.9) in 2016 to 552.8 (95% CI 549.4-556.1) in 2019. Then it declined to 331.2 (95% CI 328.6-333.8) in 2020 and rebounded to 465.1 (95% CI 462.1-468.1) in 2021, which was still below the prepandemic level. Regression analyses show that the presence of newly confirmed COVID-19 cases was significantly associated with a lower AH rate. As for other factors, higher densities of primary physicians were linked to lower AH rates. Moreover, AH rates were also associated with population structure, the level of economic development, and demographic variables.

CONCLUSIONS: The AH rate in Beijing exhibited a consistent upward trend before the pandemic and remained higher than in many high-income countries. These characteristics suggest a potential overuse of tertiary care and highlight the necessity for health care system reforms in Beijing, particularly a transition from the hospital-centered model to a primary care-focused delivery system. In addition, the observed associations between AH rates and factors, such as pandemic shock and socioeconomic variables, indicate that AH should be interpreted with appropriate controls when it is used as an indicator of primary care performance.

PMID:40609083 | DOI:10.2196/69768

JMIR Cancer. 2025 Jul 3;11:e71062. doi: 10.2196/71062.

ABSTRACT

BACKGROUND: Breast cancer survivors have increased cardiovascular risk compared to those without cancer history. Cardiovascular disease is the most common cause of death in breast cancer survivors. Cardiovascular risk in breast cancer survivors is impacted by both cancer treatment-associated effects and in risk factors for breast cancer and cardiovascular disease overlap. Strategies to improve screening for and management of cardiovascular disease in breast cancer survivors are needed to improve the delivery of survivorship care.

OBJECTIVE: This study aims to assess current cardiovascular risk counseling practices and perceived cardiovascular risk in breast cancer survivors.

METHODS: Semistructured interviews were conducted from May to December 2021 with breast cancer survivors identified as having a primary care clinician within an academic family medicine center in Charleston, South Carolina. The interview guide and content were developed using the Health Belief Model with a focus on cardiovascular risk behaviors, risk perception, and barriers to risk reduction. Analysis of categorical data was conducted by frequency and quantitative variables by mean and SD. Template analysis was performed for qualitative analysis. Outcome measures included self-reported history of cardiovascular disease, risk perception, and risk behaviors.

RESULTS: The average age of participants (n=19) was 54 (SD 7) years; 68% (13/19) were White and 32% (6/19) were Black or African American. Of the interviewed women, 90% (17/19) reported a personal history and 90% (17/19) reported a family history of cardiovascular disease. Only 53% (10/19) had previously reported receipt of cardiovascular counseling. Primary care most commonly provided counseling, followed by oncology. Among breast cancer survivors, 32% (6/19) reported being at increased cardiovascular risk, and 47% (9/19) were unsure of their relative cardiovascular risk. Factors affecting perceived cardiovascular risk included family history, cancer treatments, cardiovascular diagnoses, and lifestyle factors. Video (15/19, 79%) and SMS text messaging (13/19, 68%) were the most highly reported mechanisms through which breast cancer survivors requested to receive additional information and counseling on cardiovascular risk and risk reduction. Commonly reported barriers to risk reduction such as physical activity included time for meal planning and exercise, resources to support dietary and exercise changes, physical limitations, and competing responsibilities. Barriers specific to survivorship status included concerns for immune status during the COVID-19 pandemic, physical limitations associated with cancer treatment, and psychosocial aspects of cancer survivorship.

CONCLUSIONS: Breast cancer survivors identified that factors associated with their cancer diagnosis and treatment both impacted their cardiovascular risk and introduced additional barriers to risk reduction. Potential strategies to improve counseling and awareness around cardiovascular risk include video and messaging platforms. Further risk reduction strategies should consider the unique challenges of cancer survivorship in delivery and implementation.

PMID:40609074 | DOI:10.2196/71062

Neurology. 2025 Aug 12;105(3):e213717. doi: 10.1212/WNL.0000000000213717. Epub 2025 Jul 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: Alzheimer disease and other dementias are accompanied by depression and agitation and other behavioral and neuropsychiatric symptoms. In 2023, brexpiprazole became the first antipsychotic approved by the US Food and Drug Administration to treat agitation in persons with Alzheimer disease, but, like all atypical antipsychotics, it includes a black box warning of an increased risk of mortality among persons with dementia. This study provides real-world evidence of mortality in a heterogeneous sample of brexpiprazole users to understand effects in the population.

METHODS: We used a 100% sample of Medicare claims data Parts A, B, and D from 2014 to 2023. Our sample was limited to beneficiaries with diagnosed dementia, who were continuously enrolled for at least 2 years and were new users of the atypical antipsychotics brexpiprazole or aripiprazole in a given year. We used matching and logistic regression to estimate the relationship between incident use of brexpiprazole, compared with aripiprazole, and mortality, emergency department (ED) visits, and hospitalization within 6 months.

RESULTS: Among the 41,871 beneficiaries with dementia, 71.7% of brexpiprazole and 69.7% of aripiprazole users were women with a mean age of 75.7 and 78.0 years, respectively. Among persons living with dementia (PLWD), 6-month mortality was statistically lower among new users of brexpiprazole based on estimates from logistic regression and a matched sample of new users of brexpiprazole or aripiprazole (OR 0.49, [95% CI 0.37-0.65]).There was no statistical difference between the incident use of brexpiprazole and aripiprazole use for ED visits or hospitalization within 6 months of use initiation. Adjustment for potential unobserved confounding used two-stage least squares estimation and found no statistically significant differences in six-month mortality, ED visits, or hospitalizations between the 2 groups.

DISCUSSION: Brexpiprazole use is not associated with differential mortality risk compared with aripiprazole use among PLWD. Brexpiprazole offers a treatment option which is important given the heterogeneity of effects of antipsychotics on persons. A two-stage least squares method is used to eliminate bias on estimates because of observed and unobserved differences between the 2 groups, but the small sample size is a limitation.

CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that brexpiprazole does not increase the risk of mortality at 6 months compared with aripiprazole in PLWD.

PMID:40609065 | DOI:10.1212/WNL.0000000000213717

Neurology. 2025 Aug 12;105(3):e213796. doi: 10.1212/WNL.0000000000213796. Epub 2025 Jul 3.

ABSTRACT

BACKGROUND AND OBJECTIVES: The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.

METHODS: Data are from the Analysis of Pooled Data from Randomized Studies of Thrombectomy More Than 6 Hours After Last Known Well collaboration, a patient-level meta-analysis of 6 randomized trials of EVT beyond 6 hours after last known well, with an enrollment period from September 2014 to March 2019. Patients who were also part of the HERMES collaboration data set were excluded from the analyses. The HERMES-24 score was calculated as the sum of the patient’s age/10 and NIH Stroke Scale (NIHSS) score at 24 hours after randomization. The predictive ability of the score for a 90-day outcome (modified Rankin Scale [mRS] scores ≤2 and ≤3, ordinal mRS score, and mortality) was investigated.

RESULTS: Among 435 patients (48.5% men, median age 71 years), the median onset-to-randomization time was 654 (interquartile range 516-849) minutes and the median baseline NIHSS score was 16 (interquartile range 13-21). The HERMES-24 score was predictive of 90-day mRS scores ≤2 and ≤3, ordinal mRS score, and mortality in both the EVT arm (n = 223, c-statistic [95% CI] 0.917 [0.875-0.944], 0.895 [0.853-0.938], 0.820 [0.745-0.891], and 0.849 [0.776-0.922], respectively) and the control arm (n = 212, c-statistic [95% CI] 0.921 [0.872-0.969], 0.879 [0.827-0.930], 0.805 [0.746-0.852], and 0.805 [0.738-0.871], respectively).

DISCUSSION: The HERMES-24 score was highly predictive of 90-day outcome among patients with stroke due to LVO and small ischemic core for those presenting in the late time window, irrespective of intervention. This score must be further validated in a real-world clinical setting if it is applicable to all patients with LVO admitted in late time windows.

PMID:40609063 | DOI:10.1212/WNL.0000000000213796

Prev Chronic Dis. 2025 Jul 3;22:E33. doi: 10.5888/pcd22.240429.

ABSTRACT

INTRODUCTION: Timely access to stroke care reduces death and disability due to stroke. Studies have investigated disparities in access by sociodemographic characteristics but not comorbidity prevalence. We used updated data to assess both types of disparities in drive times to certified stroke centers nationwide.

METHODS: We conducted a cross-sectional spatial analysis of drive time from each contiguous US census tract (N = 72,517), using population-weighted centroids, to any certified stroke care (n = 1,825) or advanced (ie, endovascular-capable) stroke care (n = 426), using 2022 data from multiple state and nationwide databases. We compared median comorbidity prevalence and sociodemographic characteristics for census tracts within versus beyond a 60-minute drive time, using US Centers for Disease Control and Prevention PLACES 2020 data.

RESULTS: Median (interquartile range) drive time was 11.8 (7.6-21.6) minutes to any certified stroke care, and 23.0 (12.6-53.9) minutes to advanced stroke care. Approximately 20% of the US adult population (n = 49 million) resided in census tracts beyond a 60-minute drive from advanced stroke care; most (65%) were rural. Census tracts more than 60 minutes from advanced stroke care had significantly higher prevalence of stroke, high blood pressure, coronary heart disease, high cholesterol, diabetes, chronic kidney disease, fair or poor self-rated health status, smoking, and obesity. They also had higher poverty rates, lower educational attainment, lower median income, and higher proportions of non-Hispanic White people and people older than 65 years.

CONCLUSION: Residents in census tracts lacking timely access to stroke care have higher prevalence of health risk factors. The results highlight areas where education, telehealth infrastructure, and facility placement could improve stroke systems of care.

PMID:40609022 | DOI:10.5888/pcd22.240429

Prev Chronic Dis. 2025 Jul 3;22:E34. doi: 10.5888/pcd22.240509.

ABSTRACT

INTRODUCTION: Nationally representative estimates of mental health symptoms and services in adults with kidney disease are limited. The objective of this study was to examine the mental health status and use of health care among adults with and without kidney disease.

METHODS: We used data from the 2021 National Health Interview Survey. Diagnosed kidney disease is based on adults who reported ever being told by a doctor or other health professional that they had weak or failing kidneys. The survey question captures data on adults who are aware of having kidney disease and most likely have advanced kidney disease. Mental health measures examined were serious psychological distress (SPD), current symptoms of anxiety and depression, diagnosed anxiety and depressive disorder, prescription medication use for these disorders, and receipt of counseling. We used logistic regression models, with predicted marginal proportions, to calculate unadjusted and adjusted prevalence ratios, controlling for sociodemographic and health characteristics.

RESULTS: About 2.9% of adults reported having a diagnosis of kidney disease; prevalence varied by sociodemographic and health characteristics. The prevalence of SPD; current symptoms of anxiety or depression or both; history of diagnosed anxiety or depression or both; and receiving counseling and prescription use for these disorders were higher among adults with kidney disease than among adults without kidney disease. In multivariable models adjusted for sociodemographic and health characteristics, adults with diagnosed kidney disease remained more likely than adults not diagnosed with kidney disease to experience mental health conditions and receive counseling.

CONCLUSION: A survey of the US population found a higher prevalence of poor mental health and receipt of mental health care among people diagnosed with kidney disease than among people not diagnosed with kidney disease.

PMID:40609021 | DOI:10.5888/pcd22.240509

Biodemography Soc Biol. 2025 Jul 3:1-27. doi: 10.1080/19485565.2025.2527033. Online ahead of print.

ABSTRACT

Fertility policy directly affects the fertility decisions of residents’ families, and has the greatest impact on the daily lives of China’s residents and on the country’s economic and social development. In recent years, as the demographic situation has changed, China’s fertility policy has undergone a series of adjustments, and the government has implemented different incentives in the legal system, child care, education, and maternity insurance to stimulate fertility intention. This is a major shift in China’s fertility policy from “family planning” to “fertility support.” In the process of policy adjustment, a series of problems emerged. First, the continuous adjustment of the fertility policy causes information gaps among departments at different levels, thus leading to coordination difficulties and a lack of responsibility between the upper and lower levels of policy implementation. Second, the implementation of the two-child policy is ineffective, and its incentive effect fails to meet the expected standard. Therefore, this paper explores the similarities and policy effectiveness of fertility policies and uses the LDA thematic clustering model, cosine similarity distance algorithm, and PMC index evaluation system to quantitatively analyze fertility policies in different periods. The results are as follows: (1) due to changes in China’s demographic structure, China’s fertility policy has adjusted significantly during the universal two-child period, and its policy content and specific measures have changed dramatically compared with those of the previous period, while China’s fertility policy has stabilized during the universal three-child period. (2) In the policy effectiveness evaluation, most policies have undetailed long-, medium-, and short-term goals and lack adequate policy guarantees. Therefore, to build a perfect fertility support system, the government needs to comprehensively consider the synergy of policy measures, the strengthening of policy guarantee programs, and the enhancement of policy effectiveness in the formulation of relevant policies, to continuously make policies more targeted, scientific, and effective.

PMID:40608994 | DOI:10.1080/19485565.2025.2527033

Ann Med. 2025 Dec;57(1):2527359. doi: 10.1080/07853890.2025.2527359. Epub 2025 Jul 3.

ABSTRACT

OBJECTIVE: This study aims to investigate the influence of the COVID-19 lockdown period on anxiety, anger, loneliness and depression, four categories of negative emotions, in patients undergoing maintenance hemodialysis.

METHODS: A cross-sectional survey was conducted, and a total of 174 patients receiving maintenance hemodialysis at the Second Affiliated Hospital and Fourth Affiliated Hospital Hemodialysis Center of Anhui Medical University between October 20 and October 27, 2022, were selected as the study subjects. We used the Medical Staff Stress and Negative Emotions Scale (MSSNS) to assess the emotional changes in anxiety, anger, loneliness and depression in these patients before and during the lockdown.

RESULTS: A total of 174 questionnaires were collected, all of which were valid. During the lockdown period, the scores for anxiety (18.89 ± 6.83), anger (10.20 ± 3.32), loneliness (10.86 ± 3.81) and depression (14.13 ± 4.24) were significantly higher than the scores before the lockdown for anxiety (16.63 ± 4.64), anger (9.74 ± 2.60), loneliness (10.26 ± 3.35) and depression (13.11 ± 4.24). These differences were statistically significant (p < 0.001).

CONCLUSION: During the COVID-19 lockdown, patients undergoing maintenance hemodialysis experienced significantly higher levels of anxiety, anger, loneliness and depression compared to the pre-lockdown period. Our study emphasizes the importance of paying sufficient attention to the mental health of hemodialysis patients during such public health crises.

PMID:40608972 | DOI:10.1080/07853890.2025.2527359

PLoS One. 2025 Jul 3;20(7):e0326972. doi: 10.1371/journal.pone.0326972. eCollection 2025.

ABSTRACT

Various hypotheses regarding the origin of menopause have been proposed, and although the kin-selection-based theory appears promising, it involves population genetic processes that are insufficient to compensate for loss of fitness. The grandmother hypothesis and its variation the live long hypothesis is untenable; the former requires “climbing a steep fitness hill”, as grandmothers share only 25% of their genes with their grandchildren, compared to 50% with their direct offspring, while the latter proposes a prolongation of the post-menopausal lifespan through selection, which is not possible in a population of non-reproducing females. The mate choice theory explains menopause as the result of asymmetric mating involving younger females and older males that leads to an accumulation of infertility mutations and the evolution of menopause in older females. In this study, we investigated the mate choice theory using an infertility mutation accumulation experiment with Drosophila melanogaster that involved mating between individuals of different age groups. After 70 generations of asymmetric mating, the results showed that younger females who were paired with older males showed declining fertility in old age. The same trend was noted with younger males when mated with older females; the fertility of the males declined in old age. These results support the mate choice theory and indicate that menopause is not a life history trait of females but of the sex of the younger mate. Mate choice theory treats the evolution of menopause and post-menopausal lifespan as independent traits that are driven by the mate choices exercised by older males. Menopause may be an atypical process because the evolutionary mechanism (age-restricted asymmetric mating) involved is rarely observed in nature.

PMID:40608892 | DOI:10.1371/journal.pone.0326972